If your company ever comes to Redmond for a health industry briefing at our Executive Briefing Center, or you happen to attend one of the many keynotes I give at industry conferences throughout the year, you'll more than likely see what is known as our Health Future Vision video.
This is the third such health industry video we have produced here at Microsoft. It has been my pleasure to work closely with Ian Sands and his Industry Innovations Group (IIG) to bring these videos to life. What's particularly interesting is how accurate the videos have been in predicting future industry trends and how technology will influence the way we work. Perhaps that's because IIG does so much internal and external research before producing one of these videos. We also base them on technology that is either currently available but not widely implemented, or on technology that is being actively pursued in the labs at Microsoft Research. In any event, everything you see in the video is based on technology that is available now, or is very likely to be available within a 7 to 12 year time frame.
Our newest Future Vision Video also captures the essence of healthcare industry trends that I've been following and writing about for the last few years. This includes the rising tide of consumerism in healthcare, the retail movement, commoditization of services, information everywhere, and globalization.
In the video, we follow a young pre-diabetic patient as she ventures out on a run. During her run, various physiologic functions are being monitored and data is being sent in real time to her personal health record.
A case manager, who has been given permission by the patient to see her data, becomes aware that she may qualify for a new clinical trial. When the young woman returns home she enters into a virtual consultation with her case manager who directs her to check with her personal physician about possible enrollment in the study. She immediately schedules a "virtual conference" with her personal physician.
The scene switches to the young woman's endocrinologist as he beings to make rounds in a hospital. He uses a very light-weight Tablet computer to gather information on his patients, locate needed equipment, and conduct his patient visits.
We see him performing a retinal exam on one of his diabetic inpatients and sharing results with the patient.
He later enters a special room where he conducts a "virtual visit" with the young woman we saw at the beginning of the video. The physician, his patient, and a clinical researcher collaborate on details of the proposed clinical trial.
The doctor instructs his patient to visit a nearby retail setting, where as the video comes to a close, we see her using her "digital wallet" and a kiosk to get necessary tests and medication for the clinical trial.
I think the video accurately reflects the kind of consumer-directed, quality and price transparent, knowledge-driven healthcare delivery system we'd all like to see. And while this is just a video, it certainly captures the essence for how information technology will help transform medical practice to better connect people and data, facilitate improved collaboration, and better inform everyone involved.
Now that you understand the storyline, please take a few moments to watch the video: Enjoy!
Bill Crounse, MD Worldwide Health Director Microsoft Corporation
Somebody has to pay for all this. The real question is who?
As always, thanks for your comments Guest. I think you know the answer to your question. We all pay more than we should right now because of medical errors, duplicate tests, unnecessary procedures, inefficient and burdensome administrative processes, wasted time...... need I go on? What if we could direct all that wasted money to actually caring for patients? What if doctors had the full range of contemporary communication and collaboration technologies at their disposal? What if we could deliver exactly the most appropriate level of care whenever and wherever it was needed. What if doctors could be reimbursed for providing cognitive services so that an e-mail replaced an office visit, or a "virtual house call" prevented a trip to the ER? What if, indeed!
Bill Crounse, MD
Interesting post. But why not post the video? Is there somewhere that we can see it, without an invite to the Executive Briefing Center?
Thanks Mike. I wish I could stream the video so everyone could enjoy it; but for now we can only use it when presenting "live" at the briefing center or at major industry conferences. Perhaps sometime in the future we can post it so anyone can see it. Until then, it serves as a little extra incentive to come to one of my keynotes.
Bill Crounse, MD
My hunch is that if you put your video on youtube or somesuch you would get far more people turning up for your keynotes than you could handle, people eager to hear you elaborate on the video's message. What better way is there to raise awareness for what you're doing?
Living in England, there is little likelihood of me hearing you in person. But you can bet that if I got hold of your video it would soon be circulated around some movers and shakers in the UK's medical industry. Surely this is what you must want?
I include an email address in the hope that you agree! gray.elkington(at)hammersmithremovemedicine(dot)com (take out the word 'remove').
Me? My role is to find the technology doctors need to innovate.
>We all pay more than we should right now because of >medical errors, duplicate tests, unnecessary procedures, >inefficient and burdensome administrative processes, >wasted time...... need I go on?
This is because of bad top management of healthcare organizations who are more interested in maximizing the profits instead of delivering good care. As everything, this is not a technology problem but political one.
>What if doctors could be reimbursed for providing >cognitive services so that an e-mail replaced an office visit, >or a "virtual house call" prevented a trip to the ER? What >if, indeed!
Do you honestly belive that this will reduce the cost??? I doubt so. This will improve throughput of patients so that practice can charge same for shorter time, effectively growing profits. On related note, cost of 'cognitive services' is impossible to measure and patients will still be charged high fees which have no basis. Hospital will prefer take someone to ER just because they can get paid by insurance. No insurance company will ever reimburse for 'virtual house call' because this things will make them bancrupt. Similarly, if you are a patient who is about to die (otherwise why would you need to be in ER) why do you want a 'virtual house call'?
To fix the problem you need to find its root cause. The true state of affairs is that patient wants to be healthy and get best care possible, doctors want to be paid for their services and insurances/payers want maximize profits. This are the driving forces of healthcare. That is why cost is so high.
The REAL SOLUTION to the problem is to have healthcare for everyone to be paid by from tax money, in other words socialized medicine like that in Canada, UK or European Union countries. This is the first step in the right direction.
Technology works irrespective of country and political system.
Yes, the REAL SOLUTION is socialized medicine. Everyone knows that it is more important to obtain chiropractic services, as opposed to a heart catheterization (check into Canada's socialized medicine). Read-up and learn about how many Canada-US border towns have to ship-out cases to the US because they have major access issues.
Sure - it is easy for those of us with healthcare insurance to balk at the rationing of care and significant wait times for many critical services that would evolve with socialized medicine but in a few years there would just be yet-another two-tier healthcare system (as exists in the European countries now) and more people would be complaining. We are now taking appropriate care of more individuals that we would in a socialized medicine environment. Please remember that we have socialized medicine now, it is called Medicare, Medicaid and charity care. Place your focus on Grassley who will reduce charity care with his actions (that is, more regulation, more reporting, more government red tape, burning more dollars and resources that could be directed to better alternatives).
Gray, Guest and Art;
Thanks for taking time to comment. I really didn't intend to ignite a debate on healthcare reform, nor will I take a hard line on whether public or private healthcare systems are best. Both have their strengths and weaknesses. What seems to get lost in the debate is that healthcare is always rationed no matter what system is in place because no society can afford to do everything for everyone. That's just economics 101. My interest is in how technology can be leveraged to reduce waste, increase quality, and improve access to a wider range of information, services, and appropriate levels of care no matter what system (public or private) is in place.
Bill Crounse, MD
Being an Endocrinologist with an "Electronic Office" I find the arguments compelling.
After 5 years of using EMR technology and providing the options of managing diabetes via e-visit concept for almost 3 years, I continue to find that IT companies are woefully deficient in undestabding the requirements of providing health care and insurers are (intentionally or otherwise) uninterested in providing appropriate financial incentives for physicians willing an able to utilise IT to improve quality of care.
Taking Bill's specific video as an example, I find several practical flaws that would make this scenario nearly impossible to achieve under current conditions. Firstly, very few insurances recognise th condition of "pre-diabetes" - it took several years to just get a diagnosis code for this (extremely important) condition. Second, the procedure code for such an (virtual) interaction with a patient is not recognised for payment by almost all insurers. Third, the tablet pc that the physician is using for this visit is currently entirely funded by the physician with no hope of ever being able to recover the cost from the consumers of health care - there is no mechanism for this. As a similar example, if my accountant uses e-filing for my taxes, the extra cost is directly charged to me (for this convenience). But if I ever ask my patients to pay for such a service it is considered fraud under existing insuerere contracts. Fourth, if the physician is making rounds at more than one hospital, there is no way he/she can use the same program to access two hospital systems.
While Bill's concept is good, society has to decide if its ready to accept that quality health care has to be reimburse appropriately, just like every other service. IT companies have to develop special pricing options for medical practices and detailed regulations are needed to prevent IT companies from taking medical practices for a ride.
I havemyself struggled for over a year to convince our major insurance carriers to recognise that chronic diseases like diabetes require a "continuous care" model for which e-visits or virtual visits are ideal and offer most efficient, timely and effective care. But they seem to be far from even considering such services as "reimbursable" even though there are billabe codes with reimbursement values attached to such codes. I wonder how Microsoft plans to address these critical issues in order to make such a futuristic plan workable in today's world.
Thanks Doctor Cavale,
Thanks so much for your insightful comments. Believe me! No one knows better than me that physicians are held hostage by a payment system that stifles innovation and rewards the status quo. However, market forces are at work that will change the game. As consumers are being asked to pick up an increasingly larger share of their healthcare spend, they are being forced to make more informed choices about when they get their care and who delivers it. They will also make choices increasingly driven by technology. Early examples of this can be seen in the growth of web traffic and services related to health, the rise of medical tourism, the expansion of the retail health movement, and innovative service providers such as TelaDoc. My colleague, John Goodman, offers an excellent quick read on some of these market trends in an editorial appearing today on his Blog at http://www.john-goodman-blog.com/entrepreneurship/.
The coming changes will likely be more evolutionary than revolutionary, but the evidence of change is all around us. Furthermore, I believe that it will be forward-thinking, entrepreneurial physicians like many of the docs who comment on this Blog who will lead the way.
Bill Crounse, MD Worldwide Health Director Microsoft
Thanks for the comments, Bill. John Goodman's blog while very spirited, is not very accurate. I have to wholeheartedly disagree that Minute Clinics with NPs can be classified as an innovation, nor can I agree that blindly following computerised protocols is evidence-based practice. Its the "dumming of medicine". If this is innovation, I will try my best to stay away from it. I would like to see how a single multi-million dollar law suit at one of these clinics will affect their growth. I also wonder how the Liability Insurance premiums for these independently practicing NPs are as compared to independently practicing physicians. I only hope they are comparable...
I am interested in ways to help the patient understand how to manage her or his care. When you have multiple medical problems, with multiple protocols, how do you understand the medical context around attending to them? Take management of chronic pain for example. You can: visit a chiropractor, have Reiki healing, take pain medicines, rest, walk, meditate, sit in a hot tub, take cold baths, whatever. This requires the patient to track effects and continue to learn what works and what doesn't. And when someone is in pain, that can be daunting. Maybe even have an advocate who helps articulate what is or is not working. This medical system is so fragmented, I suggest you think of ways to help the patient integrate information. We now get so many instructions verbally or tersely written down, and we don't always know the context in which they were made.
Thanks for your comment. I agree that the "patient experience" is less than optimal in healthcare. There are so many conflicting sources of information, and even the most trusted sources of information have been known to flip-flop as scientific evidence evolves (i.e. hormone replacement therapy or the debate on trans-fats). The good news is that companies like Microsoft, Yahoo, Google and others are working hard to develop new tools to help consumers find and use health information on the web, and new ways for consumers to connect with healthcare providers and medical services. Then too, as the healthcare industry moves toward electronic record keeping, our ability to analyze clinical data will improve. This should speed the development of better, highly efficacious and more personalized treatment options.
Microsoft has always been on the cutting edge and I am interested in following the advances you make. I am a emergency department nurse administrator and would love to assist in this project. Are you looking for any healthcare professionals to assist in this endeavor?
Thanks for writing. Our healthcare groups at Microsoft are growing fast with more than 600 people now directed at developing or selling healthcare solutions around the world. We have many clinicians and other people with deep industry experience on our staff. I generally advise people who are looking for career opportunities at Microsoft to visit www.microsoft.com/careers and perform a keyword search using the term "healthcare" to survey open positions and opportunities.
Bill Crounse, MD Worldwide Health Director Microsoft